Job Description
LPN Case Review
Category: Clinical Services
Job Type: Fully remote
Salary: 21.75 – 47.25
Job Description:
Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand with heart at its center our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.
Position Summary
You will provide processing and communication of specialty medication prior authorization (PA) requests reviewed by the Caremark Specialty Medical Prior Authorization department. Reporting to the Pharmacy Operations Manager, you will work with physician office staff and customer service, admissions and pharmacy operations departments to communicate prior authorization status. You will also oversee fax processing and provide telephone call assistance for prescriber office staff, pharmacies and members based on program criteria. Responsibilities include answering inbound phone calls, processing cases, loading authorizations, and making follow-up phone calls. Maintaining complete and accurate, documentation of all necessary information is necessary and will involve computer system data entry, data management, and reporting.
Review criteria-based prior authorizations following policy and procedure
Provide on-call after hours nurse availability for urgent PA requests
Provide internal nurse support to the PA team and member services department Refer cases not meeting clinical criteria to the Pharmacist and MD team(s).
Shift priorities while exhibiting a high level of urgency with all calls and assignments.
Excellent verbal and written skills.
You will work with pharmacists, other clinical colleagues, healthcare professionals and members.
Follow all prior authorization procedures to guarantee an accurate process on each prior authorization.
Train and mentor representatives on the PA team. Complete other PA assignments as delegated by the PA leadership team.
Required Qualifications
Prior work experience working prior authorizations in Novologix.
Excellent interpersonal skills, Demonstrated problems solving ability and attention to detail, Ability to work effectively in a team environment with great dependability, Excellent oral and written communication skills, Ability to quickly assess and adapt to constantly changing situations, phone and PC use, Required to possess a high mental agility and alertness. Ability to effectively communicate with pharmacists, other clinical colleagues, healthcare professionals and members; Ability to effectively prioritize work while exhibiting a high level of urgency with all calls and assignments; Follows all prior authorization procedures to ensure a timely and accurate process on each prior authorization; Ability to effectively train and mentor representatives on the PA team; Execute other PA assignments as delegated by the PA supervisor or manager.
Preferred Qualifications
0 to 3 years prior work experience
Associate’s or Bachelor’s Degree in Nursing
Education
Associate s or Bachelor s Degree: Nursing preferred
Active LPN license in the state of practice required